Behind the glittering gold medals and world records, elite athletes often face hidden struggles. Famous Olympic gymnast Simone Biles struggles with anxiety, swimmer Michael Phelps with ADHD, and 2024 100 meter gold medalist, Noah Lyles, wrestles with asthma. All are prime examples of elite athletes juggling care of their own health and their athletic endeavors, whether that be mental, physical or emotional. According to PubMed Central, 34% of active athletes report symptoms of depression or anxiety.
Modern medicine plays a prominent role in many young adults’ lives today, offering relief and treatment for a wide range of health conditions. However, when it comes to athletes, the use of these medicines may cause complications. The physical demands of athletic performance often clash with – or even cause – struggles of anxiety, depression, and mood swings. From managing acne to treating chronic conditions, the impact of these drugs can influence not only an athlete’s physical well-being, but their everyday performance, recovery and overall mental health as well.
One common neurodevelopmental condition among teenagers and student-athletes is Attention Deficit Hyperactivity Disorder (ADHD). The Centers for Disease Control and Prevention (CDC) reports that between 2020 and 2022, 11.3% of adolescents aged 5-17 were diagnosed with ADHD. Students with ADHD often struggle with focusing, completing tasks, and maintaining a consistent attention span. They may also experience mood swings and other related challenges.
A variety of medications are available to help manage the symptoms of ADHD, each with its own benefits and side effects. Two commonly prescribed medications are Concerta and Ritalin. Both of these have helped senior and varsity lacrosse player Oliver Chancellor navigate the challenges of ADHD.
“[the prescription] makes it much easier to focus on what my coach is saying or what play we are running,” Chancellor said. “When I play without my medication, I tend to lose focus a lot more, which can be very detrimental in a close game.”
However, the benefits of these medications often come with trade-offs, as Chancellor has experienced firsthand. Chancellor discusses the impacts on his social and athletic interactions.
“My medication makes me less social, so it’s harder to communicate during practices and games,” Chancellor said.
This side effect can be particularly challenging when participating in team sports, where effective communication is crucial to success on the field. Yet, for Chancellor, the most significant challenge is not a mental aspect but a physical one.
“The hardest thing about taking my medication is the appetite loss,” Chancellor said. “I don’t eat much during the school day because my medication completely suppresses my appetite, which makes it much harder to train in general.”
For a varsity athlete who is expected to perform at such a high intensity, this effect can be particularly weakening.
“Playing any sport on an empty stomach is difficult, but it’s especially tough for a physically demanding sport like lacrosse,” Chancellor said.
Chancellor is not the only student who faces this issue. Junior baseball player Jackson Sims also struggles with similar challenges while on Adderall, another medication commonly used to treat ADHD.
“[the prescription] definitely affects my appetite,” Sims said. “I don’t eat very much, because when I’m on my medication, it really makes me not hungry at all, which makes me have less stamina. This also makes it very difficult to gain weight.”
However, unlike Chancellor, Sims chooses to adjust his medication schedule in order to manage this effect.
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“I don’t take my medication on weekends because I want to have an appetite, and I don’t really need it since I don’t have to focus on much during that time,” Sims said. “However, I do take a smaller dose before sports games to help with focus.”
Sims has found that managing his medication has an impact on his daily life and athletic performance, and notes a difference between taking and not taking his medication.
“When I don’t have my Adderall, I don’t really pay any attention, and I don’t really have much motivation,” Sims said. “When I’m on it, I’m focused.”
Similarly, managing health conditions presents a significant challenge for student-athletes diagnosed with type 1 diabetes. Individuals diagnosed with type 1 diabetes’ pancreas fail to produce enough insulin, the hormone necessary for regulating glucose levels in the blood. Without enough insulin glucose cannot enter cells (typically muscle, fat, and liver cells) and instead, is found in the bloodstream, leading to high blood sugar. Symptoms of high blood sugar include excessive thirst, blurred vision, fatigue, weight loss, nausea, and vomiting (Mayo Clinic).
In order to cancel out these symptoms, athletes with type 1 diabetes must regularly administer prescribed doses of insulin. However, balancing insulin levels can be complicated, as different situations require varying dosages. Rapid or short-acting insulin is typically used to manage blood sugar spikes during meals, while intermediate or long-acting insulin maintains the body’s general glucose needs. For athletes, particularly those in the early stages of managing their diabetes, the process of adjusting insulin doses to accommodate physical activity can take time.
Sophomore basketball player Ella Hoy, diagnosed with type 1 diabetes four years ago, understands these challenges firsthand.
“I had already been playing basketball when I was diagnosed, and I had to take a couple weeks off when I was in the hospital, and also to get used to my new treatments,” Hoy said. “When I was finally ready to come back, I was constantly monitoring my blood sugar while I was playing.”
Hoy has since established a routine, but managing blood sugar remains a challenge to balance during practices.
“If I give myself too much insulin before I exercise, my blood sugar will go low during practice, and I’ll have to stop in order to treat it,” Hoy said. “It’s difficult to remember every time, but before practice I will usually turn down the levels of my dosage so that my blood sugar doesn’t go low at practice. I also have to constantly check my blood sugar during practice so that if I’m going low, I can treat it before I go too low and have to stop, and that kind of disrupts my practice.”
Details of Hoy’s treatment appear harsh, but without the usage of medication to treat her condition, the alternative suffering would be much worse.
While some effects have a more noticeable impact on an athlete’s daily life, others may be more subtle. Dr. Heather Brandling-Bennett, a Pediatric Dermatologist who’s an attending in the Division of Dermatology at Seattle Children’s Hospital and an adjunct Professor at the University of Washington School of Medicine, treats both athletes and non-athletes of all ages. Dr. Brandling-Bennett highlights some of the treatments she frequently prescribes to athletes.
“When I think about athletes, [prescriptions] that I more commonly prescribe that may affect them include oral isotretinoin, known to many under the previous brand name of Accutane, for acne,” Brandling-Bennett said.
This oral medication is typically used to treat severe or moderate acne. Though isotretinoin can be highly effective, it also comes with potential downsides.
“Oral isotretinoin can cause a list of potential side effects, including dry lips, skin, and nose, muscle aches, and photosensitivity, as well as the need for frequent visits and intermittent laboratory testing,” Brandling-Bennett said.
One of the most challenging side effects for athletes on isotretinoin, like junior water polo player Maeva Herbert-Paz, is the increased sensitivity of the skin, especially to environmental factors such as chemicals and sunlight.
“There have been cases where [my skin] doesn’t interact well with chlorine, and in really harsh sunlight, tretinoin makes your skin super sensitive to sun,” Herbert-Paz said. “So there was a time where I did get a second-degree burn on my face, and my entire face blistered, which was extremely painful.”
Medication can influence not just physical aspects such as appetite or skin, but also a student’s mental well-being. For a number of student athletes, antidepressants can play a crucial role in enhancing mental health, and are an effective way to treat depression, anxiety, obsessive-compulsive disorder, or other mental health conditions. An anonymous Field Hockey sophomore is one such example.
“My meds have helped me get out of a really hard place. I had no energy and no passion for things that I loved,” Anonymous (‘24) said. “I spent so much time being dizzy, unmotivated, and tired at practice. After upping my dose and being patient with it, I started to see a difference. I was finally able to work to my best ability and feel good about myself.”
Anonymous Field Hockey sophomore’s experience shows how medication can improve both mental health and performance. Similarly, many women rely on contraceptives to manage severe menstrual symptoms and maintain their well-being.
The effects of menstruation can vary for all women. Extreme side effects include cramps, bloating, mood swings, headaches, fatigue and all-over body pain. Junior Mila Bynum is starting her second year on the varsity girls water polo team and was prescribed both the pill and an IUD (Intrauterine Device) for a specific reason.
“Part of the reason I started taking the pill in the first place was because I had PMDD, which is post menstrual dysmorphic depression,” Bynum said. “Basically, it’s when your mood swings are crazy and irrational the week before your period. So, I started taking [the pill] in order to alleviate those, which is why I think it helped me, since it caused me to get less frustrated, which would help me in practice.”
Bynum believes that her experience with contraceptives is positive and allows her to perform at new athletic levels that would have been otherwise difficult.
“I would perform a lot worse the week before my period, especially swimming,” Bynum said. “But now that I don’t get my period, I’m not affected as much, and with the IUD, I feel like I am performing better.”
Paly alumni (‘24) Mary Henderson has also been prescribed a birth control pill by her doctors. Henderson is a former goalie for the Paly girls water polo team and will be continuing her athletic career in college.
“Luckily, I feel there are very few side effects to the medication I take because I have worked with my doctors a lot to find a medication that is a good fit for me and has limited side effects,” Henderson said. “In the past I have tried other medications that have given me stomach aches or headaches and from there after giving it a chance, my doctor switched my medication.”
While Bynum and Henderson have experienced overall performance improvements while using birth control, like any medication, it comes with potential downsides. Dr. Danielle Kamis is a female Sports Psychiatrist who works with athletes from various disciplines ranging from individual sports like tennis, track and field, and swimming, to team sports like soccer, basketball, and hockey. Dr. Kamis provides information about what effects birth control can have on athletes.
“Progestin, a synthetic form of progesterone found in many birth control pills, can lead to challenges such as mood swings, fatigue, and decreased physical performance, due to its effect on hormonal balance,” Kamis said.
VO2 max is a measure of how much oxygen an athlete uses during training. A higher VO2 max is more optimal; it means your body is more efficient at delivering oxygen to working muscles. According to Rupa Health, evidence shows that an oral contraceptive may lower VO2 max in female athletes, causing them to feel like they cannot give their 100%, which can be very detrimental to athletic performance.
“VO2 max is a measure of an athlete’s aerobic capacity, indicating how efficiently the body can use oxygen during exercise,” Kamis said. “A low VO2 max means that an athlete will struggle with endurance, and their ability to sustain high levels of physical activity will be limited. For female athletes, this can be particularly problematic in sports requiring significant stamina, such as long-distance running, cycling, or soccer.”
Another major risk factor of using birth control as an athlete is the possibility of reducing total testosterone. Women with low testosterone may experience fatigue, muscle weakness, depressions, or other mood disorders, which also negatively impacts their athletic performance.
To address these challenges, Kamis suggests several strategies that can help female athletes manage the impact of hormonal shifts on their performance.
“Some ways female athletes can overcome these challenges include tailoring your birth control: working with a healthcare provider to find the right type of contraceptive that minimizes negative side effects,” Kamis said. “This might mean switching pills or using different forms of contraception, such as IUDs or implants, that release lower levels of progestin.”
One other option Kamis mentions: adjustments to diet and exercise. “Paying close attention to nutrition and adjusting training intensity around the menstrual cycle may help mitigate fatigue or mood-related issues,” Kamis said.
In addition to the physical side effects that birth control may have on athletic performance, such as reduced testosterone levels and fatigue, maintaining mental sharpness is equally critical. Focus, often cited as the most important skill for athletes, plays a pivotal role in ensuring success during competition. Dr. Kamis highlights the mental health challenges athletes face, including those linked to medications like birth control.
“Athletes face unique mental health challenges that stem from high pressure, performance expectations, and the intense training regimens they follow,” Kamis said. “My role is to help them navigate these mental health challenges and sometimes the psychological effects that can arise from injury, competition, or drug-related issues. Seeking counseling or therapy to manage mood swings and emotional challenges associated with hormonal shifts can be beneficial as well.”
According to website Believe Perform, focus is the most essential component to supporting success. Focus allows athletes to attend to critical cues and concentrate on tasks to achieve success. The ability to focus allows athletes to achieve their goals.
“Personally, my medication is essential to my training, specifically my anxiety medication,” Henderson said. “It allows me to focus less on my anxiety and stress and more on what I care about, my training.”
For many athletes, the path to finding the right medicine or dosage can be daunting, and with so many nuances and side effects, it can often take years to find the right fit. One of the major responsibilities that comes with taking prescription medications is the daily ritual. Most if not all medications are supposed to be taken on a daily basis at similar times everyday. Missing days of medication can have consequences both mentally and physically.
“I have accidentally gone off my medication, which resulted in extreme symptoms like nausea, dizziness, lightheadedness, and more,” Henderson said. “I was accidentally taking a different medication because I forgot to read my pill bottle. After that experience, I am very careful about staying on top of taking my medication and consistently set alarms for taking my medication and have pill organizers to make sure I do not miss a day.”
Fortunately, recent advancements offer hope for reducing the stress of managing medications. The healthcare industry is evolving rapidly, driven by technological innovations. One significant development that minimizes the trial-and-error process in prescribing medications is the use of Artificial Intelligence. AI can analyze individual patient data and make informed decisions about the most suitable medication(Global PPh). For now, however, many athletes continue to shoulder the responsibility of balancing these challenges.
Ultimately, the consequences of medicines can be hard to avoid, particularly when they are taken out of necessity. For athletes on prescribed medications, balancing their treatment with the demands of their sport requires careful management, as consequences sometimes interfere with their performance and well-being. Luckily, finding resources such as doctors to help experiment with proper doses and timing for athletes can help one to navigate the stress of medicating.
